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Biomedical subjects

F J Kazmier

Publications and source records attributed to F J Kazmier.

At least 19 recordsLinked to original sources
PubMed1993

Financial impact of thoracoabdominal aneurysm repair.

We have reviewed our experience regarding hospital costs and reimbursement for 72 patients who underwent thoracoabdominal aneurysm repair. Preoperative risk factors, postoperative complications, length of stay, and source of reimbursement were recorded for all patients. Patients covered by Medicare resulted in a mean net institutional loss of $16,472 per patient, whereas a mean net profit of $17,847 per patient resulted from patients with commercial insurance. Factors associated with institutional financial loss were: age over 75 years, preoperative coronary disease, postoperative respiratory failure, and length of stay. By multivariate analysis, however, only length of stay was independently associated with institutional loss.

Adult↗
PubMed1993

Comparison of operative reconstruction and percutaneous balloon dilatation for central venous obstruction.

To evaluate the efficacy of venous reconstruction versus percutaneous transluminal angioplasty for the treatment of obstruction of the superior vena cava and its major tributaries, we retrospectively reviewed the clinical course of 27 patients, of whom 13 underwent operative reconstruction and 15 had angioplasty (1 had both). Three patients had obstruction of the superior vena cava, 8 had occlusion of the innominate veins, and 16 had obstruction of the subclavian or axillary veins. In both treatment groups, mean age, indications, etiology, and location of the lesion were comparable. No major surgical complications occurred; one patient who underwent angioplasty experienced stent migration to the pulmonary artery without sequelae. Primary symptomatic relief at 1 year was achieved in 88% in the surgical group versus 36% in the angioplasty group (p < 0.05 by Fisher's exact test) and at 2 years in 71% versus 0%, respectively (p < 0.01). One- and 2-year success rates with repeated angioplasty, however, were 86% and 66% (p > 0.9), respectively. We conclude that the long-term success rate of operative reconstruction exceeds that of single percutaneous transluminal angioplasty. However, with repeated angioplasty, success rates approach those of operative reconstruction.

Aged↗
PubMed1993

Screening and managing abdominal aortic aneurysms at the Ochsner Clinic: suggested algorithm and method of derivation. Department of Surgery and Ochsner Clinic Quality Assurance Committee.

An algorithm for screening and management of abdominal aortic aneurysms was developed at the Ochsner Medical Institutions to address the considerable variation identified in clinical practice. A consensus panel of physicians whose opinions differed regarding the management of abdominal aortic aneurysms was convened to develop the algorithm. Based on a literature review and clinical experience, the panel established criteria to determine how frequently and by which methodologies patients with abdominal aortic aneurysms should be followed and when a referral to a vascular surgeon is appropriate. The algorithm developed by the consensus panel method was used to establish practice guidelines that are flexible enough to address individual patient needs yet structured enough to eliminate inappropriate care. Data are being collected and analyzed in real time to determine whether elements of the algorithm should be revised.

Aftercare↗
PubMed1993

Direct replacement of mycotic thoracoabdominal aneurysms.

Direct graft replacement with local debridement and prolonged administration of antibiotics was used in the treatment of six patients with mycotic thoracoabdominal aneurysms. The only early death occurred in a patient with systemic sepsis related to Staphylococcus aureus mycotic suprarenal aneurysm. Long-term survival of the remaining patients has been excellent: two patients died of unrelated causes at 5 and 6 years, respectively; one patient remains alive with known persistent infection at 5 years; and the remaining patients are alive with no evidence of infection at 1 1/2 and 10 years, respectively. Percutaneous aspiration of infected perigraft fluid with local instillation of antibiotics along with administration of intravenous antibiotics may provide palliation in selected patients with recurrent infections. In view of the magnitude of the problems associated with recurrent infection, life-time administration of antibiotics is recommended after in situ graft replacement of mycotic thoracoabdominal aneurysms.

Adult↗
PubMed1992

Risk of spinal cord dysfunction in patients undergoing thoracoabdominal aortic replacement.

The records of 150 consecutive patients undergoing thoracoabdominal aortic replacement from 1980 to 1991 were retrospectively reviewed. There were 89 men and 61 women; mean age was 67.8 years (range: 33 to 88 years). Since June 1989, a multimodality prospective perioperative protocol was used to reduce the risk of spinal cord dysfunction. Ischemia is minimized by complete intercostal reimplantation whenever possible, cerebrospinal fluid drainage, and maintenance of proximal hypertension during cross-clamping. Spinal cord metabolism is reduced by moderate hypothermia, high-dose barbiturates, and avoidance of hyperglycemia. Reperfusion injury is minimized by the use of mannitol, steroids, and calcium channel blockers. Ninety-seven percent of patients survived long enough for evaluation of their neurologic function. Spinal cord dysfunction was reduced from 6 of 108 (6%) in the preprotocol group to 0 of 42 in the protocol group (0%) (p less than 0.01). The overall 30-day operative mortality was not significantly different between the groups (9% versus 12%, p = NS). A multimodality protocol appears to be effective in reducing the risk of spinal cord injury during thoracoabdominal aortic replacement.

Adult↗
PubMed1992

Selection of patients for peripheral revascularization surgery.

The recognition of the extent of vascular disease has introduced several medical subspecialties, radiology and vascular surgery, to a multidisciplinary approach to these problems. Of particular importance is the primary care physician, who often is the first to see these patients and should be familiar with common vascular problems. Only then will initial care and disposition be appropriate.

Humans↗
PubMed1991

"Shaggy" aorta syndrome with atheromatous embolization to visceral vessels.

Spontaneous atheromatous visceral embolization from diffuse aortic atherosclerotic disease is an unusual and poorly understood entity. We have reviewed our experience with 88 patients who suffered atheromatous embolization from a "shaggy" aorta. Visceral embolization was evident in 36 patients (40.9%). Nine were treated nonoperatively with three patients dying within a week of presentation and an additional five patients dying within five years due to continuing renal and intestinal embolization. Surgical correction was undertaken 28 times in 27 patients. Endarterectomy or graft replacement of the aorta did not necessarily prevent visceral infarction or renal failure. Extra-anatomic bypass with ligation of the distal external iliac arteries appears to be associated with the lowest morbidity and mortality. Anticoagulation of these patients does not prevent embolization and may be contraindicated for long-term management.

Aged↗
PubMed1991

Progression of peripheral occlusive arterial disease in diabetes mellitus. What factors are predictive?

The clinical, biochemical, and vascular laboratory measurements potentially associated with the development and/or progression of peripheral occlusive arterial disease (POAD) were assessed during a 4-year period in 110 normal control subjects, 112 patients with POAD without diabetes mellitus, 240 patients with diabetes mellitus without POAD, and 100 patients with diabetes mellitus and POAD. Age, history of hypertension or coronary heart disease, history of cigarette smoking, presence of POAD, systolic blood pressure, and beta-thromboglobulin level were associated with progression of POAD. A multivariate logistic regression model indicated that the presence of diabetes mellitus or POAD or both at baseline, decreased postexercise ankle-brachial index, increased arm systolic blood pressure, and current smoking were independently associated with progression of POAD. This study suggests that cessation of smoking and control of hypertension are essential treatment modifications to decrease the risk of progression of peripheral vascular disease in diabetic patients.

Arterial Occlusive Diseases↗
PubMed1990

Course of peripheral occlusive arterial disease in diabetes. Vascular laboratory assessment.

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patients with diabetes mellitus and peripheral occlusive arterial disease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.

Amputation, Surgical↗
PubMed1989

Necrobiosis lipoidica diabeticorum: platelet survival and response to platelet inhibitors.

Results of an open trial of platelet inhibitor treatment for necrobiosis lipoidica diabeticorum suggest the possible importance of abnormal platelet function in this disease. In ten female patients with necrobiosis lipoidica diabeticorum (six who were diabetic and four who were not) platelet survival times were measured before and after treatment with aspirin and dipyridamole. Pretreatment platelet survival time was considerably shortened in 50 percent of the diabetic and nondiabetic patients. Platelet-inhibitor treatment prolonged platelet survival time toward normal in most of these patients. The clinical response to treatment varied from healing to no noticeable effect.

Adult↗
PubMed1988

Myocardial infarction, persistent coronary artery thrombosis and lupus anticoagulant.

A 40-year-old man who presented with exertional angina had had two myocardial infarctions within the same myocardial distribution several years earlier. Coronary arteriography revealed a large intramural thrombus in the right coronary artery and minimal atherosclerotic disease. Special coagulation studies detected a circulating lupus anticoagulant. The association of repeated episodes of thrombosis and lupus anticoagulant is important. In patients with repeated thrombotic events, the lupus anticoagulant should be sought, particularly in those less than 40 years of age.

Adult↗
PubMed1988

Heparin-induced thrombocytopenia and thrombosis in ischemic stroke.

We reviewed the records of all patients who underwent carotid endarterectomy at our institution during the period from January 1970 through December 1986 to determine the frequency of postoperative occlusions and the role of heparin-induced thrombosis in patients with such occlusions. After 2,527 carotid endarterectomies, a total of 19 occlusions occurred in 18 patients. Of these 18 patients, 6 had an associated heparin-induced coagulation disorder, 3 of whom are described in detail. Although heparin is a useful anticoagulant, it may precipitate occlusion of vessels after an endarterectomy procedure, either at the endarterectomy site or elsewhere. Physicians should be aware of the potentially increased risk for embolic or thrombotic cerebrovascular events in patients who receive heparin therapy.

Aged↗
PubMed1988

The penetrating aortic ulcer: pathologic manifestations, diagnosis, and management.

The term "penetrating aortic ulcer" refers to an ulceration of an atheromatous plaque that extends deeply through the intima and into the aortic media. It may precipitate an intramedial dissection (usually localized) or may rupture into the adventitia to form a pseudoaneurysm. The typical patient with penetrating atheromatous aortic ulcer is elderly and has hypertension, atherosclerosis, and back or chest pain, but pulse deficit, stroke, aortic insufficiency, and compromise of a visceral vessel are not present. Classic aortic dissection and symptomatic thoracic aortic aneurysms are among possibilities in the differential diagnosis. Aortography demonstrates the presence of an aortic ulcer similar in appearance to gastric ulcers seen on barium examination; in addition, an intramural aortic hematoma may be present. Our experience with penetrating aortic ulcers in symptomatic patients indicates that conservative medical therapy leads to recurrence of symptoms and a need for surgical intervention. We present a case that illustrates the salient features of this distinct clinical entity.

Aged↗
PubMed1987

Cardiomyopathy in patients with hereditary motor and sensory neuropathy.

Twelve affected persons in the third decade of life or later, and the 14 nearest age- and sex-matched unaffected relatives, of a large kindred with autosomal dominant hereditary motor and sensory neuropathy not linked to the Duffy blood group (HMSN type IA) were assessed for arrhythmia and cardiomyopathy. Cardiac abnormalities were no more frequent in the affected persons than in the unaffected relatives. The heart of a patient with HMSN type II who had died of complications of cardiomyopathy was found to have rheumatic disease-type myocarditis with Aschoff bodies. The results of this study provide further evidence against an association of cardiomyopathy and HMSN.

Adult↗
PubMed1987

Optic neuropathy and amiodarone therapy.

Optic neuropathy has been diagnosed in several amiodarone-treated patients, including the 13 patients described in this report. The clinical severity of this drug-related optic neuropathy is milder than that characteristically described in anterior ischemic optic neuropathy. The incidence of occurrence was significantly higher than that found in an age-matched general population sample. Whether this result was due solely to amiodarone therapy, to the underlying poor health of these patients, or to a combination of these two factors is uncertain. The findings in this study prompt us to recommend that all patients who receive amiodarone undergo complete ophthalmologic examinations, including careful evaluation of the ocular fundus regularly during such therapy. Appearance of optic neuropathy is probably a relative indication for discontinuing the use of the drug, in the hopes of avoiding bilateral involvement or perhaps recovering vision. The risks of complications of amiodarone treatment must be weighed against the benefit of therapy in patients whose lives are threatened by cardiac arrhythmias. On the basis of this study, the benefits of treatment seem to outweigh the small risk of optic neuropathy. No randomized study has been undertaken to determine the true incidence of complications associated with this medication and at this time could not be justified.

Aged↗
PubMed1987

Deep venous thrombosis and pulmonary embolism. Risk of subsequent malignant neoplasms.

We conducted a noncurrent prospective study of all Olmsted County, Minnesota, residents who had had a lower-extremity venogram, pulmonary angiogram, or lung scan performed because of suspicion of deep venous thrombosis or pulmonary emboli. One hundred thirteen cancer-free patients were followed for 386 person-years from the date of procedure. Nine subsequent cancers were observed compared with 4.5 expected (relative risk, 2.0; 95% confidence interval, 0.9 to 3.8), using total cancer incidence rates for the Rochester, Minn, population. Five hundred seventeen cancer-free controls were followed for 2072 person-years. Twenty subsequent cancers were observed compared with 11.6 expected, yielding a relative risk of 1.7 (95% confidence interval, 1.1 to 2.7). When cases and controls were compared directly, no statistically significant difference in cancer-free survival was found.

Follow-Up Studies↗
PubMed1987

Late survival in abdominal aortic aneurysm patients: the role of selective myocardial revascularization on the basis of clinical symptoms.

Coronary artery disease is recognized as the major cause of perioperative and late death after abdominal aortic aneurysm (AAA) repair. Routine coronary angiography and prophylactic myocardial revascularization for all significant lesions, regardless of symptoms, have been recommended as a means of reducing this mortality risk. We have advocated a more selective approach in which coronary angiography and myocardial revascularization are performed on the basis of cardiac symptoms. Studies have shown that this selective approach is just as effective as the prophylactic approach in reducing perioperative deaths. To evaluate the effect on late survival of selective myocardial revascularization on the basis of symptoms, we reviewed the preoperative coronary status and course of 485 patients who successfully underwent AAA repair between 1980 and 1985. Late survival was evaluated by means of the Kaplan-Meier method and compared with life expectancy of an age- and sex-matched population. Late survival of the entire group of patients was no different from that of the matched population. Patients with no preoperative evidence of coronary artery disease did significantly better than expected (p = 0.05), whereas those patients with uncorrected or previously bypassed coronary disease had survival no different from that expected. When age was considered as a variable, patients in their 50s and 60s had survival significantly worse than the matched population (p less than 0.001 and p = 0.003, respectively). Patients in their 70s and 80s had survival as good as or better than the matched population, regardless of coronary status.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗